Intermittent explosive disorder (IED): When anger becomes uncontrollable

Picture this: You’re at the grocery store when someone ahead of you erupts into a screaming rage over a simple checkout delay. Or maybe it’s closer to home: A friend who seems calm one moment, then explodes into violent anger over something seemingly trivial, leaving everyone around them shaken and confused.

When these emotional explosions appear to come from nowhere, escalate rapidly, and leave destruction in their wake—whether that’s broken relationships, damaged property, or physical harm—there may be more at play than just a “bad temper.” You might be witnessing intermittent explosive disorder (IED), a real and treatable mental health condition that affects millions of people.

If you’ve ever wondered how to help someone during these frightening outbursts, or if you’re concerned that you or someone you love might be struggling with uncontrollable anger, you’re not alone. Understanding IED is the first step toward finding effective ways to manage it and reclaim emotional control.

What Is Intermittent Explosive Disorder? 

Intermittent explosive disorder (IED) is a mental health condition characterized by sudden, intense outbursts of anger and aggression that seem completely out of proportion to whatever triggered them. People with IED experience recurring episodes of impulsive, aggressive behavior that they struggle to control, often targeting those closest to them.

These aren’t just moments of losing your temper. IED episodes are intense, overwhelming experiences that can include:

• Emotional flooding: Sudden waves of rage, anger, irritability, and crushing tension that feel impossible to contain
• Verbal aggression: Explosive yelling, cruel verbal attacks, heated arguments, and threatening language
• Physical aggression: Hitting, slapping, throwing objects, destroying property, or threatening violence against people or animals
• Physical symptoms: Racing heart, muscle tension, trembling, headaches, and a surge of overwhelming energy

From the outside, these reactions look completely irrational—like someone detonating over a minor inconvenience. The episodes typically last around 30 minutes before burning out, often leaving the person feeling drained, remorseful, and deeply embarrassed about their behavior.

“IED can influence a person’s impulse control and emotion regulation skills, causing intense behavioral eruptions,” says Alexandra Cromer, a licensed professional counselor at Thriveworks. “Because of this, the disorder has the potential to significantly impact someone’s daily life in multiple areas, including their personal and professional relationships.”

Who Does IED Affect?

In the United States, between 1.7 to 2.6 million people live with intermittent explosive disorder. While it can be diagnosed as early as age six, most people receive their diagnosis during late childhood or early adolescence. However, many adults struggle with undiagnosed IED, often having learned to avoid situations that might trigger their explosive anger.

Signs and Symptoms of Intermittent Explosive Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), signs and symptoms of an intermittent explosive disorder episode include:

• Explosive yelling and verbal outbursts
• Physical violence toward people or objects
• Intense, heated arguments that escalate rapidly
• Damaging or destroying property
• Threatening or harming people or animals
• Periods of intense regret and shame following episodes

People with IED may also experience physical warning signs before and during episodes, including headaches, muscle tension, heart palpitations, tremors, and sudden surges of energy. Episodes typically last around 30 minutes before subsiding, often leaving the person feeling exhausted and remorseful.

The frequency varies greatly—some people with IED have explosive episodes regularly, while others go weeks or months between outbursts. What distinguishes IED from ordinary anger is the intensity, the disproportionate reaction to triggers, and the significant distress or impairment it causes.

The only way to know for sure if you have intermittent explosive disorder is to see a mental health professional. They can observe your symptoms, make a diagnosis, and create a personalized treatment plan that’ll help you successfully manage your disorder.

What Does an IED Episode Feel Like?

For someone experiencing an IED episode, it can feel like being hijacked by your own emotions. The experience often begins with mounting tension, like pressure building in a steam kettle with no release valve.

“An IED episode is characterized largely by strong, sudden feelings of dysregulation,” Cromer says. “The intensity of the emotions grow until they explode, with irritability leading to yelling, shouting, impulsivity, destruction of property, and potential for violence against themselves or others.”

Before the explosion: You might notice warning signs like headaches, muscle tension, or heart palpitations. Some people describe feeling their energy spike or experiencing an overwhelming sense of agitation. However these warning signs aren’t always clear until it’s too late—episodes can feel random even to the person experiencing them.

During the episode: Think of it as “seeing red.” Your body floods with energy and tension that builds until it bursts out all at once. In the moment, anger and impulse take complete control, with little regard for consequences. Many people describe feeling like they’re watching themselves from the outside, unable to stop what’s happening.

After it’s over: Most people feel immediate relief as the pressure finally releases, followed by exhaustion. Later comes the regret, embarrassment, and often confusion about what just occurred. The contrast between the person’s normal state and their behavior during the episode can be jarring for everyone involved.

What makes IED particularly challenging is its unpredictability. While stress and conflict can be common triggers, episodes can feel sudden and random, making them difficult to predict or prevent without proper treatment.

Impact of IED on Children and Adults

Intermittent explosive disorder doesn’t just affect the person experiencing it. The ripple effects touch every area of life and everyone close to them. The emotional volatility and unpredictability can have profound consequences across multiple domains.

• Relationships and social connections: The explosive nature of IED puts enormous strain on relationships. Family members, friends, and romantic partners may feel like they’re constantly walking on eggshells, never knowing what might trigger an outburst. This creates an environment where others feel unsafe or uncomfortable, making it difficult to form and maintain meaningful connections.
• Work and school performance: Professional and academic settings don’t tolerate explosive behavior well. Lashing out at colleagues, supervisors, or classmates is typically seen as unprofessional and disruptive. This can lead to job loss, academic suspension, or difficulty maintaining stable employment or educational progress.
• Emotional and psychological well-being: Beyond the interpersonal damage, IED takes a toll on the person’s mental health. “The emotional dysregulation caused by IED can cause someone to experience difficulty focusing, concentrating, and completing tasks,” notes Cromer. The constant cycle of explosive episodes followed by shame and regret can severely impact mood and emotional stability.
• Self-perception and confidence: Perhaps most devastatingly, IED can erode a person’s sense of self. “Experiencing significant emotional outbursts and perceived minimal control over impulses and experienced moods can make someone feel self-critical and like they are a ‘bad person,’ when in reality, they have very little control over their actions and emotions,” Cromer explains.

The good news is that IED is highly treatable. With proper support and intervention, people can learn to manage their symptoms effectively and repair the relationships and life areas that have been damaged.

What Type of Disorder Is Intermittent Explosive Disorder?

IED is classified as one of the five impulse control disorders, a category that also includes oppositional defiant disorder (ODD), conduct disorder, kleptomania, and pyromania. What these conditions share is difficulty controlling specific behaviors or impulses.

More specifically, IED is considered a distinct, taxonic behavioral disorder rather than a dimensional disorder. This means it exists as its own separate condition, not just as the extreme end of a spectrum of aggressive behavior. You either have IED or you don’t; it’s not simply a matter of being “more aggressive” than most people.

This classification is important because it helps mental health professionals understand that IED requires specific treatment approaches rather than general anger management techniques.

IED and Co-Occurring Conditions

While IED is its own distinct condition, people with IED have a high likelihood of being diagnosed with other mental health conditions at the same time. Some of the most commonly found co-occurring conditions include:

• Substance use disorder (SUD), which affects about 31% of people with IED
• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)
• Post-traumatic stress disorder (PTSD)
• Agoraphobia, affecting about 8% of people with IED
• Social anxiety, which can develop as a result of explosive episodes

Depressive symptoms are particularly common and often associated with increased hostile behavior and difficulties with social adjustment. The combination of depression and explosive anger can create a particularly challenging cycle.

However, it’s important to understand that “IED can and regularly does exist on its own,” according to Cromer. Having IED doesn’t automatically mean you’ll develop other conditions, though the stress of managing explosive episodes can increase vulnerability to other mental health challenges.

IED vs. Other Mental Health Disorders

Because explosive anger can be a symptom of several mental health conditions, IED is sometimes misdiagnosed or confused with other disorders. Understanding the key differences helps ensure accurate diagnosis and appropriate treatment.

Disruptive Mood Dysregulation Disorder (DMDD)

Similarities: Both disorders involve angry, aggressive behavior and are primarily diagnosed in childhood or early teens.

Key differences:

• Mood consistency: DMDD involves constant irritability; IED has calm periods between episodes
• Duration requirements: DMDD requires persistent symptoms for at least a year; IED episodes are brief outbursts
• Age limits: DMDD only diagnosed in children ages 6-18; IED can be diagnosed in adults

Bipolar Disorder

Similarities: Both can involve irritable behavior, impulsivity, and emotional outbursts.

Key differences:

• Episode duration: Bipolar episodes last days or weeks; IED episodes last around 30 minutes
• Mood patterns: Bipolar involves major mood swings between depression and mania; IED episodes are isolated anger bursts
• Between episodes: Bipolar affects overall mood states; IED behavior returns to normal between outbursts

Oppositional Defiant Disorder (ODD)

Similarities: Both involve irritable, angry moods that can seem triggered by minor issues, along with argumentative behavior and conflict with others.

Key differences:

• Behavior consistency: ODD shows constant irritability over six months; IED episodes are intermittent
• Target focus: ODD often targets authority figures; IED can affect anyone, especially close relationships
• Response to episodes: IED involves genuine remorse; ODD tends toward blaming others and avoiding responsibility

Accurate diagnosis is crucial because each condition requires different treatment approaches. If you’re concerned about explosive anger in yourself or a loved one, a mental health professional can help distinguish between these conditions and develop an appropriate treatment plan.

What Causes Intermittent Explosive Disorder?

Like many psychiatric conditions, intermittent explosive disorder develops from a combination of biological, psychological, and environmental factors working together.

Biological Factors

Research shows that people with IED have specific brain differences:

• Serotonin abnormalities: Lower levels of this mood-regulating neurotransmitter
• Amygdala hyperactivity: Stronger fear and anger responses in the brain’s emotional center
• Prefrontal cortex issues: Difficulty with impulse control and emotional regulation

Risk Factors

Several factors can increase the likelihood of developing IED:

• Childhood trauma: Exposure to violence or explosive behavior creates a strong risk
• Gender: More common in men than women
• Age: Most diagnoses occur in childhood and teens, with majority under age 40
• Family history: Genetic predisposition may play a role
• Other mental health conditions: Anxiety, mood disorders, and substance use can increase risk

Understanding these risk factors can help with early identification and intervention, though having risk factors doesn’t guarantee someone will develop IED.

How to Help Someone During IED Episodes

If someone you care about has intermittent explosive disorder, there are specific ways you can help during their outbursts. Keep in mind that people experiencing IED episodes are dealing with incredibly intense emotions, making rational conversation nearly impossible.

De-escalation Strategies

Communication approaches:

• Use empathetic statements: “It sounds like you’re really hurt”
• Validate their feelings without condoning harmful behavior
• Listen actively and show you’re engaged
• Avoid ultimatums or power struggles
• Offer positive reinforcement when they regain control

Physical presence:

• Respect personal space while staying close enough to help
• Use calm body language and a soothing tone
• Don’t mirror their emotional intensity

Problem-solving focus:

• Ask “What can we do to fix this?” to promote collaboration
• Suggest cooling-off periods as face-saving alternatives
• Focus on solutions, not blame or rehashing events

Keeping Everyone Safe

For loved ones, IED episodes can feel like walking on eggshells. If the person becomes verbally or physically abusive—which is never acceptable—prioritize safety:

• Remove access to weapons or dangerous objects
• Have an escape plan ready if you feel threatened
• Call 911 immediately if physical safety is at risk
• Remember: You are not responsible for de-escalating someone else’s anger

While these strategies can help, your loved one must take responsibility for their emotional health by working with a mental health professional to manage their condition effectively.

How Is Intermittent Explosive Disorder Treated?

IED is highly treatable with the right combination of professional support and personal strategies. Treatment is typically long-term but can effectively help people manage their symptoms and rebuild their relationships.

Therapy for IED

• Cognitive behavioral therapy (CBT): Helps identify triggers, improve communication, and learn relaxation techniques like breathing exercises and progressive muscle relaxation. CBT also uses cognitive restructuring to change thinking patterns and prevent future outbursts.
• Dialectical behavior therapy (DBT): Focuses specifically on emotional regulation and behavior change through mindfulness techniques, distress tolerance strategies, and grounding exercises to better handle stress.
• Psychodynamic therapy: Explores past experiences and unconscious patterns to understand how they impact current behavior, working to heal trauma and identify underlying triggers.

Medication Options

Common medications for IED include antidepressants, anti-anxiety medications, and mood stabilizers. Fluoxetine (Prozac), an SSRI antidepressant, is the most researched and effective medication for treating IED.

Medication isn’t always necessary—your provider will assess your specific symptoms and severity to determine the best treatment approach for you.

Personal Management Strategies

Learning to recognize and manage episodes before they escalate is crucial:

• Creative outlets: Art, music, and writing can help process emotions and provide healthy expression
• Communication skills: Reach out to trusted friends or family when you feel emotions building—but do this early, not during an active episode
• Grounding techniques: Practice breathing exercises, the 5-4-3-2-1 technique, or other calming strategies. “Skills such as deep breathing, using senses to calm yourself, drinking cold water, or doing anything you can to control your environment to soothe and calm are critically helpful,” Cromer says.
• Know your triggers: “One of the best ways to begin to calm yourself during an IED episode is to work to understand your triggers beforehand and review mental and behavioral signals that indicate you are in an elevated state,” Cromer explains.

The key is practicing these techniques when you’re calm so they’re available when you need them most.

Can IED Be Cured?

While there’s no cure for intermittent explosive disorder, it can be successfully managed with proper treatment. The goal is helping people regulate their emotions and outbursts so they can live fulfilling lives and maintain healthy relationships.

Getting Diagnosed and Finding Help

If you’re concerned about IED symptoms in yourself or someone you know, start with a mental health professional who can:

• Conduct a thorough evaluation using tools like the IED screening questionnaire (IED-SQ)
• Rule out other conditions with similar symptoms
• Develop a personalized treatment plan

Remember: A diagnosis is not an identity; it’s typically the first step toward getting the help you need to regain control over explosive anger and rebuild damaged relationships.